Abdominal pain / by J.H. Musser.

  • John Herr Musser
Date:
1904
Catalogue details

Licence: In copyright

Credit: Abdominal pain / by J.H. Musser. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    for similar reasons, mural atrophy, the muscle spasm is wanting. (6) It disappears with the onset of toxemia, and hence a rapidly lessening resistance with the slightest evidence of advancing toxemia, as indicated by the expression, the tongue, the pulse- rate, the mental condition, even though the temperature fails, is of grave significance. It may be found that the leukocytes do not increase, but may even fall to a moderate height, as 9,000 to 12,000 or even less, as we also find in grave pneumococcus infec- tions, when a moderate leukopenia may be present. Tenderness of Cutaneous Surface. Hyperalgesia. — Hilton, Head, Mackenzie, and others have repeatedly called attention to alterations of cutaneous sensibility in the distribution of spinal nerves related to affected organs within the body. Sherren1 has called renewed attention to this cutaneous hyperalgesia, elicited by the head of a pin or some blunt instrument. That such hyperalgesia may exist is well known, but the point I wish to make is, if it exists and then disappears, as may also spasm and pain, the change is of ill omen unless all other symptoms subside. The absence of, or rather the disappearance of hyperalgesia means the occurrence of gangrene or perhaps perforation. The accompanying illustrations show the distribution of cutaneous hyperalgesia in appendicitis. They are taken from Sherren’s article. PAIN IN ABDOMEN DUE TO GENERAL CONDITIONS The Intoxications. I shall pass over that due to lead-poison- ing, only venturing to reinforce the warning of Janeway, and speak of abdominal pain due to uremia. The French authors have long since called attention to this symptom, and many years ago I made a verbal communication to the West Philadelphia Medical Society on it. I had seen it, as had likewise the French observers, in or preceding the uremic convulsions of puerperal nephritis. In the instances under my observation the pain was in the epigas- trium and both hypochondria. Only recently I was asked to see a case of alleged severe indigestion with cramps in a woman who had been delivered four hours previously, and who had nephritis 2